一次性与可重复使用的带 FANS 的软性输尿管肾镜：来自欧洲泌尿外科学会 - 腔内泌尿外科分会和 FANS 协作组的一系列大型病例的多中心倾向匹配结局分析

Single-use versus reusable flexible ureterorenoscopes with FANS: a multicenter propensity-matched analysis of outcomes in a large series from the EAU-Endourology Section and FANS Collaborative Group.

作者信息

Giulioni Carlo, Castellani Daniele, Falsetti Federico, Bhojani Naeem, Chew Ben Hall, Yuen Steffi Kar Kei, Shrestha Anil, Contreras Pablo, Palaniappan Sundaram, Chong Tsung Wen, Cafarelli Angelo, Zhu Wei, Zeng Guohua, Quan Yi Tan, Kwok Jia-Lun, Fong Khi Yung, Pietropaolo Amelia, Herrmann Thomas, Traxer Olivier, Somani Bhaskar Kumar, Gauhar Vineet

机构信息

Department of Urology, Casa di Cura Villa Igea, 60127, Ancona, Italy.

Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126, Ancona, Italy.

出版信息

World J Urol. 2025 Jun 26;43(1):399. doi: 10.1007/s00345-025-05769-0.

DOI:10.1007/s00345-025-05769-0

PMID:40569462

Abstract

OBJECTIVE

This study compares the clinical outcomes of single-use and reusable flexible ureterorenoscopes (fURS) in retrograde intrarenal surgery (RIRS) with flexible and navigable suction access sheath (FANS).

METHODS

A multicenter prospective analysis included 704 patients who underwent RIRS with FANS between July 2023 and March 2024. Patients were stratified into two groups: those treated with single-use fURS (Group 1, n = 263) and those with reusable fURS (Group 2, n = 441). Propensity score matching (PSM) was used to reduce confounding in the statistical comparisons. The primary outcomes were stone-free rate (SFR) and complication rates, assessed through pre- and postoperative non-contrast computed tomography (NCCT) scans. Statistical analyses were performed using R software, with p < 0.05 considered significant.

RESULTS

After propensity score matching, 226 patients per group were well-balanced across baseline characteristics (ASMD < 0.1). Group 1 was associated with shorter laser (p = 0.001) and operative times (p = 0.048), and more frequent use of larger sheaths (p < 0.001). Complication rates were low and comparable between groups. Group 1 achieved higher 100% stone free status (65.5% vs. 55.8%, p = 0.012), though overall stone-free rates were similar. Reintervention rates did not differ significantly. Lasing and exit strategy did not differ between the two groups. On multivariate analysis, single-use scope use (OR 1.659, p = 0.018) and 10-12 Fr UAS (OR 1.749, p = 0.043) were significantly associated with complete stone clearance.

CONCLUSION

Our study findings indicate that FANS is a safe and effective technique irrespective of the type of scope used. However, as FANS offers the potential to achieve a truly 100% stone-free status, this outcome is more likely when using single-use scopes in combination with 10/12 sheaths. Given that stone volume is a significant determinant of stone-free outcomes, surgeons may consider selecting the scope type to tailor the procedure according to stone complexity.

摘要

目的

本研究比较了一次性和可重复使用的软性输尿管肾镜（fURS）在逆行肾内手术（RIRS）中联合使用软性可导航吸引鞘（FANS）的临床效果。

方法

一项多中心前瞻性分析纳入了2023年7月至2024年3月期间接受FANS辅助RIRS的704例患者。患者被分为两组：使用一次性fURS治疗的患者（第1组，n = 263）和使用可重复使用fURS的患者（第2组，n = 441）。倾向评分匹配（PSM）用于减少统计比较中的混杂因素。主要结局指标为无石率（SFR）和并发症发生率，通过术前和术后非增强计算机断层扫描（NCCT）评估。使用R软件进行统计分析，p < 0.05被认为具有统计学意义。

结果

经过倾向评分匹配后，每组226例患者在基线特征方面达到了良好的平衡（标准化均数差<0.1）。第1组的激光使用时间（p = 0.001）和手术时间（p = 0.048）较短，且更频繁地使用较大尺寸的鞘管（p < 0.001）。两组的并发症发生率均较低且相当。第1组实现了更高的100%无石状态（65.5%对55.8%，p = 0.012），尽管总体无石率相似。再次干预率无显著差异。两组的激光操作和退出策略无差异。多因素分析显示，使用一次性输尿管肾镜（OR 1.659，p = 0.018）和10-12 Fr的输尿管通路鞘（OR 1.749，p = 0.043）与结石完全清除显著相关。

结论

我们的研究结果表明，无论使用何种类型的输尿管肾镜，FANS都是一种安全有效的技术。然而，由于FANS有可能实现真正的100%无石状态，当使用一次性输尿管肾镜联合10/12鞘管时，更有可能获得这一结果。鉴于结石体积是无石结局的重要决定因素，外科医生可考虑根据结石的复杂性选择输尿管肾镜类型来调整手术方案。